Multiple sclerosis

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Main symptoms of multiple sclerosis

Multiple sclerosis

Multiple sclerosis (often abbreviated to MS, and historically known as disseminated sclerosis) is a chronic, inflammatory condition that predominantly targets the central nervous system (CNS). The disease manifests through a range of symptoms such as altered sensation, visionary disturbances, muscular weakness, depression, issues with coordination and speech, and sometimes severe pain. While many with MS manage to have fulfilling lives, the more advanced stages can notably impede mobility and lead to significant disability.

Neurological Impact[edit | edit source]

MS primarily affects neurons, which are vital cells within the brain and spinal cord responsible for transmitting information, facilitating thought and perception, and enabling the brain's command over the body. A protective fatty layer called the myelin sheath surrounds some of these neurons, ensuring efficient electrical signaling. MS gradually destroys this myelin (demyelination) and transects neuron axons, resulting in varied symptoms depending on which pathways are disrupted. The term multiple sclerosis derives from the multiple scar-like lesions (scleroses) formed on the myelin sheaths. The prevailing theory suggests MS occurs due to the immune system mistakenly targeting the nervous system, classifying it as an autoimmune disease.

Disease Progression[edit | edit source]

Multiple sclerosis can manifest in diverse patterns, either as isolated episodes with distinct symptoms or as a gradual accumulation of symptoms over time. While some may find relief from symptoms between attacks, permanent neurological damage often remains. Although significant strides have been made in understanding the pathological processes of MS, its root cause remains elusive. Unfortunately, a definitive cure for MS is yet to be identified. However, several treatments can potentially decelerate the progression of new symptoms. MS predominantly afflicts adults, usually between the ages of 20 and 40, with a higher prevalence in women than men.

Common Symptoms[edit | edit source]

The clinical manifestation of MS is vast, and patients can exhibit a plethora of symptoms. Initial MS flare-ups can be mild, transient, and may not necessitate medical attention. Only retrospective analysis after diagnosis sometimes identifies them. Common initial symptoms include: altered sensations in the extremities or face, vision loss (optic neuritis), weakness, double vision, gait disturbances, and balance issues. Around 15% of individuals present with multiple symptoms during their first medical evaluation. Many patients report their initial MS symptoms unfolding over several hours to weeks. Some also indicate a preceding infection, physical trauma, or intense physical activity triggering their initial MS episode.

Beyond the initial presentation, MS can cause a spectrum of other symptoms. These include flickering eye movements (nystagmus), speech anomalies, hand clumsiness, muscle spasms, and bowel or bladder dysfunction. Cognitive challenges, such as multitasking difficulties, trouble following intricate instructions, short-term memory loss, emotional instability, and fatigue, are prevalent. Emotional symptoms can be multifaceted, stemming from the emotional toll of living with a chronic condition or due to direct neurological damage. Common emotional challenges include clinical depression, feelings of anger, anxiety, despair, and even suicidal tendencies. Acute and chronic pain syndromes are also common among MS patients.

Distinct Clinical Phenomena[edit | edit source]

Certain clinical presentations often lead to a subsequent MS diagnosis, though it's worth noting that MS is not the exclusive cause for these:

: Optic neuritis
: Characterized by sudden onset of eye pain followed by blurring or loss of vision. This stems from the inflammation of the optic nerve. The affected vision usually improves within six months, but color perception (especially red) may remain subdued.
;Internuclear ophthalmoplegia
: Often presents as binocular double vision, especially when gazing to one side. This is due to MS impacting the medial longitudinal fasciculus in the brain stem, leading to unequal eye movement.
;Transverse myelitis
: Marked by a rapid onset of numbness, muscular weakness, and bowel or bladder dysfunction, typically in the lower body due to the spinal cord's involvement. Many affected individuals face long-term disabilities.

Diagnosis[edit | edit source]

MS poses challenges in early diagnosis. A definitive diagnosis requires evidence of at least two distinct demyelinating events, separated anatomically and occurring a minimum of thirty days apart. The McDonald criteria consolidate clinical, laboratory, and radiological data to streamline MS diagnosis across the globe.

Glossary of terms[edit | edit source]

antibodies —proteins made by the immune system that bind to structures (antigens) they recognize as foreign to the body.

ataxia — a condition in which the muscles fail to function in a coordinated manner.

autoimmune disease —a disease in which the body's defense system malfunctions and attacks a part of the body itself rather than foreign matter.

blood-brain barrier —a network of blood vessels with closely spaced cells that controls the passage of substances from the blood into the central nervous system.

cerebrospinal fluid —the colorless liquid that circulates around and through the cavities of the brain and spinal cord. Physicians use a variety of to study cerebrospinal fluid for abnormalities often associated with MS.

deep brain stimulation —therapy that uses a surgically implanted, battery-operated medical device called a neurostimulator to deliver electrical stimulation to targeted areas in the brain that control movement, blocking the abnormal nerve signals that cause tremor and other movement symptoms.

demyelination —damage caused to myelin by recurrent attacks of inflammation. Demyelination ultimately results in nervous system scars, called plaques, which interrupt communications between the nerves and the rest of the body.

dysesthesias —abnormal sensations such as numbness, prickling, or "pins and needles."

exacerbation —a sudden worsening of symptoms or the appearance of new symptoms that lasts for at least 24 hours.

fatigue —tiredness that may accompany activity or may persist even without exertion.

gray matter —part of the brain that contains nerve cells and has a gray color.

immunosuppression — suppression of immune system functions. Many medications under investigation for the treatment of MS are immunosuppressants.

interferons —signaling molecules that regulate immune cells.

lesion —an abnormal change in the structure of an organ due to disease or injury. magnetic resonance imaging (MRI)]] —a non-invasive scanning technique that enables investigators to see and track MS lesions as they evolve.

myelin —a fatty covering insulating nerve cell fibers in the brain and spinal cord, myelin facilitates the smooth, high-speed transmission of electrochemical messages between these components of the central nervous system and the rest of the body. In MS, myelin is damaged through a process known as demyelination, which results in distorted or blocked signals.

oligodendrocytes —cells that make and maintain myelin.

optic neuritis —an inflammatory disorder of the optic nerve that usually occurs in only one eye and causes visual loss and sometimes blindness. It is generally temporary.

plasma —the liquid portion of the blood that is involved in controlling infection.

plasmapheresis —the process of taking blood out of the body and removing components in the blood’s plasma that are thought to be harmful before transfusing the blood back into the body (also called plasma exchange).

plaques —patchy areas of inflammation and demyelination typical of MS, plaques disrupt or block nerve signals that would normally pass through the regions affected by the plaques.

relapsing-remitting MS —a form of MS in which an episode of symptoms occurs and is followed by a recovery period before another attack occurs.

spasticity —involuntary muscle contractions leading to spasms and stiffness or rigidity. In MS, this condition primarily affects the lower limbs.

transverse myelitis —an acute spinal cord disorder causing sudden low back pain and muscle weakness and abnormal sensory sensations in the lower extremities. Transverse myelitis often remits spontaneously; however, severe or long-lasting cases may lead to permanent disability.